For those that don’t know, I hail originally from Canada. There is a lot about America that attracts me and “Government staying out of my affairs” is a biggie. It is with no surprise then that I was very much in favor of shucking off a socialized medical system and its shortcomings for a more pay as you go system.
When I arrived here I was healthy and did not have kids so my contact with the medical system was minimal. Pretty much limited to a general physical now and then.
As I live here longer, I’m starting to grow more and more fearful of the financial repercussions of even a modest illness and find myself hesitant to take advantage of what is arguably one of the best medical systems in the world.
I’ve had a couple of procedures done over the past half decade or so and found myself annoyed that it is very difficult to get a cost for a procedure. They seem easily able to give you a bill before you go into the operating theater but try to get that bill amount when you are setting the appointment and people seem confused. On top of the, rather substantial, bill that you pay up front. The little bills that keep floating in weeks or months later are unexpected and annoying. When you call about them you will find that they are “usual and customary” but that is only for folks in the billing departments of hospitals or in insurance departments.
If I went to a mechanic and had my transmission replaced you can be sure that I am going to get an estimate from him. That estimate better be what I’m charged at the end unless something unusual comes up and, if it’s substantial, I expect a further call to ensure that I want the extra work done (maybe they notice a broken support for the engine while they’ve got the car up on the lift). You can be damn sure I’m not going to be receiving a bill from the “Oil Support Technician” or “Hydraulic Lift Specialist” two months after the fact because they consider it “Usual and Customary”.
In medicine it seems perfectly OK to have essential folks’ services completely omitted from any estimates. I had a hernia operation about 6 years ago and the anesthetist’s (or anesthesiologist’s – can never keep those two straight) services, something that I consider quite essential when I’m to be rendered unconscious for surgery, were charged for separately at least a month after the fact. I had to call to see if this was legit or some kind of scam because I was so amazed at this boldness.
I need to have an MRI to sort out some issues left over from my bicycle accident a few months back. On Friday my doctor tells me he’ll begin a precertification for this. Today I receive a call from the MRI place to schedule an appointment. I went ahead and set up a date and decided to persue this to see if it’s possible to determine one’s liability and maybe plan for this kind of thing.
The girl on the phone for scheduling, of course, can do nothing for me to help nail down the cost of this thing. So I contact my insurance company. After 15 minutes waiting on the phone I find out that my insurance company contracts out radiology type stuff to a 3rd party precertification company. I’m told I need to call back if I want to find out more about costs because their department also doesn’t handle that.
So I call the insurance company back. We’ll leave the sorry-ass IVR system out of this conversation suffice it to say that it aided me not at all in getting to a customer service rep. All the rep is able to tell me is that I’ll have a $500 deductible and then I’m responsible for 20% of the cost beyond that. OK, that’s in my benefits plan. How much does this kind of procedure cost? All he is able to tell me is that it will be a negotiated amount and that my liability will be as he’s already said.
So I contact the third party pre-cert group and find that my doctor’s office hasn’t yet initiated the precertification process with them and that my plan is the kind where only a doctor or the MRI folks can initiate the process. But that this process typically takes one business day, so my appointment (scheduled for next week) is not yet in jeopardy.
So I contact my doctors office to see what needs to be done, they acknowledge that they need to initiate this and that they’ll call me back.They call back within the hour and it turns out that this is the normal way that things are done since the pre-cert company likes to know where and when the procedure will occur. So I’ve jumped the gun on this part but they tell me that everything is now in place.
Finally I call the billing department of the MRI folks. It took them 10 minutes to figure out how much this was going to cost me. When I asked if this was an all inclusive price, explicitly mentioning that there’ll be someone administering an IV they did agree that I can expect another, separate bill from them that should only be in the range of “a hundred or so dollars”.
So, an MRI of my head, both with contrast and without will cost me no less than $868. With a little math that puts the “negotiated cost” at $2,340. Then I can expect at least another $100 bill to come floating in sometime after that for the IV person and I have no idea how many other folks it is “usual and customary” to have wander into the room while the procedure is under way and then send me a bill.
The care we have available might be some of the best in the world, but the cost for that care is terrifying – for its magnitude certainly but more so for its quixotic cost. For all its pitfalls, under a socialized medical scheme for all but the most catastrophic of issues my liability is capped so I do not have to put my self or my family at financial risk – heck it’s not even a risk because you cannot even begin to forecast the costs before you begin it’s really more of a game of chance than anything that can be calculated.
So color me leaning back in favor of the socialized medicine side of the debate. If we can get to a system where I can get off the phone with an appointment and a guaranteed estimate (representing the cost both with and without insurance) and none of those “gotchas” that make this such a risk I will rethink this. Hell I can do it for my car, my cat and my washing machine. Surely we’ve got enough knowledge and experience to estimate simple procedures accurately by now.